Evaluation of a Quality-Improvement Initiative to Address Nutritional Anemia in Gynecologic Oncology

Anemia is common among patients with gynecologic cancers receiving systemic treatment and is associated with adverse outcomes. We describe a quality-improvement initiative designed to improve screening and treatment for nutritional causes of anemia in this population, and we assess the effect of this intervention on hemoglobin levels and blood transfusions.

We implemented a quality-improvement intervention that automatized regular laboratory evaluation for nutritional causes of anemia in patients with gynecologic malignancies receiving systemic treatment who had hemoglobin levels below 12 g/dL. Patients with nutritional deficiencies were treated with intravenous iron or oral vitamin B12. We evaluated the association of the intervention and change in hemoglobin levels over three cycles of treatment (delta hemoglobin), along with the rate of blood transfusion. Thirty patients with hemoglobin levels below 12 g/dL were administered a survey regarding anemia, fatigue, and the acceptability of the intervention.

The overall rates of iron and vitamin B12 deficiency were 54.2% and 8.1%, respectively. The control period included 117 patients, and the intervention period included 101 patients. Our quality-improvement process increased the rate of evaluation for iron and vitamin B12 deficiency in patients with anemia from 23.1% and 20.5%, respectively, to more than 90%. When controlling for relevant demographic and cancer-related characteristics, the delta hemoglobin was 0.45 g/dL higher in patients treated after the intervention when compared with patients treated before the intervention. In patients with hemoglobin levels below 11 g/dL, the delta hemoglobin was 0.91 g/dL higher after the intervention. There was no significant difference in the rate of blood transfusion. Patients with anemia who were surveyed were concerned about fatigue and overall accepting of the intervention.

Using medical record treatment plans to send reflex anemia evaluation tests was effective at increasing rates of screening for nutritional deficiencies. Proactively addressing nutritional causes of anemia was associated with maintenance of higher hemoglobin levels in patients with gynecologic cancer receiving systemic treatment.